Can Wellbutrin (bupropion) and sumatriptan (Imitrex) be taken together?

Concurrent Use of Bupropion (Wellbutrin) and Sumatriptan

Bupropion (Wellbutrin) and sumatriptan can generally be used together with caution, as there is no absolute contraindication between these specific medications. 1

Safety Considerations

Drug Interactions

• Unlike monoamine oxidase inhibitors (MAOIs) which are absolutely contraindicated with sumatriptan, bupropion has a different mechanism of action and does not carry the same level of risk 1, 2
• Bupropion primarily inhibits norepinephrine and dopamine reuptake with milder effects on serotonergic activity 3
• However, caution is still warranted as:
  • Bupropion can inhibit cytochrome P450 2D6, which may increase blood levels of other medications 3
  • There is a theoretical risk of serotonin syndrome, though this appears to be rare with this specific combination

Evidence for Safety

• A study examining the concomitant use of sumatriptan with various antidepressants (including bupropion) found no significant adverse effects across 103 migraine episodes 4
• While there are case reports of serotonin syndrome with bupropion combined with SSRIs, the risk appears lower than with other antidepressant classes 3

Practical Recommendations

Dosing Considerations

• Start with standard doses of both medications:
  • Bupropion: Typically 150-450 mg daily depending on formulation 5
  • Sumatriptan: 50 mg orally for most patients, with maximum daily dose of 200 mg in a 24-hour period 1

Monitoring

• Be alert for symptoms of serotonin syndrome, including:
  • Mental status changes (agitation, confusion)
  • Autonomic instability (tachycardia, hypertension)
  • Neuromuscular abnormalities (tremor, rigidity)
  • Gastrointestinal symptoms (nausea, vomiting)

Frequency Limitations

• Limit sumatriptan use to no more than 9 days per month to prevent medication overuse headache 1
• Maintain regular dosing of bupropion as prescribed for depression/anxiety management

Special Situations

Contraindications

• Do not use this combination if the patient has:
  • Uncontrolled hypertension
  • Ischemic heart disease
  • Previous myocardial infarction
  • Prinzmetal's angina

Alternative Options

• For patients with concerns about this combination:
  • NSAIDs (ibuprofen, naproxen) may be considered for mild to moderate headaches 1
  • Combination treatments like sumatriptan/naproxen have shown efficacy for migraine treatment 6, 7

Bottom Line

While there is a theoretical risk of serotonin syndrome with any serotonergic medications, the specific combination of bupropion and sumatriptan appears to have a reasonable safety profile when used as directed. Close monitoring for adverse effects is still recommended, especially when initiating therapy.